Updates in the Management of Cerebral Infarctions and Subarachnoid Hemorrhage Secondary to Intracranial Arterial Dissection: A Systematic Review

Fawaz Al-Mufti; Naveed Kamal; Nitesh Damodara; Rolla Nuoman; Raghav Gupta; Naif M Alotaibi; Ahmed Alkanaq; Mohammad El-Ghanem; Irwin A Keller; Steven Schonfeld; Gaurav Gupta; Sudipta Roychowdhury

doi:10.1016/j.wneu.2018.09.153

Updates in the Management of Cerebral Infarctions and Subarachnoid Hemorrhage Secondary to Intracranial Arterial Dissection: A Systematic Review

World Neurosurg. 2019 Jan:121:51-58. doi: 10.1016/j.wneu.2018.09.153. Epub 2018 Sep 27.

Authors

Affiliations

¹ Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA; Department of Neurology, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA. Electronic address: fawazalmufti@outlook.com.
² Department of Neurosurgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA.
³ Department of Neurology, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA.
⁴ Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Neurology, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
⁶ Department of Neurology, University of Arizona, Banner University Medical Center, Tucson, Arizona, USA.
⁷ Department of Radiology, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
⁸ Department of Neurosurgery, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.

PMID: 30268550
DOI: 10.1016/j.wneu.2018.09.153

Abstract

Objective: Intracranial arterial dissection (IAD) is a rare cerebrovascular disease that is likely underdiagnosed because of the inherent difficulty of visualizing the subtle radiographic signs of the pathologic small intracranial arteries. No widespread consensus exists on the treatment of IAD, and thus it is often managed empirically because of the absence of major randomized controlled trials. In this study, we conducted a systematic review to evaluate the management and treatment options for IAD.

Methods: We performed a systematic review in accordance with the PRISMA guidelines using the following databases: MEDLINE (PubMed) and Cochrane Library. Included studies were limited to human patients with dissections in intracranial vessels only.

Results: A total of 82 studies were included in this systematic review. The most common complications of IAD were cerebral infarction and subarachnoid hemorrhage, and thus, patients with IAD can be subdivided into those presenting with either ischemia or hemorrhage, respectively. Those with ischemia were predominantly managed with antiplatelet therapy, whereas patients presenting with hemorrhage often were amenable to treatment with endovascular techniques.

Conclusions: Given these findings, clinicians should prescribe antiplatelet therapy for patients with IAD presenting with ischemia and consider endovascular treatment for those presenting with hemorrhage. However, further investigation is required given the heterogeneity of methods and reporting outcomes in the investigated studies.

Keywords: Aneurysm; Dissection; Hemorrhage; Intracranial; Ischemia.

Publication types

Systematic Review

MeSH terms

Aortic Dissection / complications*
Aortic Dissection / therapy
Cerebral Infarction / etiology*
Cerebral Infarction / therapy*
Disease Management
Humans
Intracranial Aneurysm / complications*
Intracranial Aneurysm / therapy
Subarachnoid Hemorrhage / etiology*
Subarachnoid Hemorrhage / therapy*